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The data indicate that the immune response that results in the formation of granulation tissue is mediated by circulating B- and/or T-cell processes rather than resident airway immune cells. Further studies focusing on cellular adaptive immune processes in response to airway injury may provide a novel treatment modality for subglottic stenosis.

In this study, vocal process granulomas occurred more frequently in men, whereas women developed granulomas only after intubation. The anti-inflammatory action of inhaled triamcinolone combined with antireflux proton pump inhibitors successfully treats most vocal process granulomas with low rates of side effects and recurrence.

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This is the first study, to our knowledge, to measure an array of protein expression within human SGS tissue. The expression profile suggests that symptomatic tracheal granulation tissue is mostly within the early inflammatory phase of wound healing and has only begun fibrotic and angiogenic remodeling. This study validates our murine model of SGS, and also helps to define the exact pathways of tissue injury, in the hope of leading to new treatments for this difficult condition.

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treatment has not been well studied in animal models. Using a previously described novel murine model, we begin to delineate inflammatory markers for potential therapeutic targets. Laryngology/Broncho-EsophagologySymptoms of laryngopharyngeal Reflux: is it Really Reflux? Michael Friedman, MD (presenter); Kanwar Kelley; Michelle Fischer; David Taylor; Alex MaleyObjective: 1) Report the accuracy of subjective Reflux Symptom Index scores (RSI) and objective Reflux Finding Scores (RFS) in identifying patients with laryngopharyngeal reflux (LPR) using ambulatory pH monitoring as confirmation. 2) Present clinical recommendations for the use of subjective and objective tools in the diagnosis of LPR.Method: Retrospective chart review of 300 adult outpatients from January 3, 2009 to December 30, 2010 in a tertiary care setting. Patients with a diagnosis of LPR based on abnormal RSI and positive findings on laryngeal endoscopic examination using RFS were tested for confirmation with a 24-hour oropharyngeal pH study using the Restech Dx-pH system.Results: Among 300 consecutive patients with an RSI score >5, 58.6% were confirmed to have reflux after undergoing 24-hour oropharyngeal pH-monitoring. Of these 300 patients, 146 had an RFS score >5. Among patients with a RSI >5 and a RFS 5 and RFS>5 the positive predictive value (PPV) increased to 71.9% (105 of 146). Therefore, when combined, an RSI>5 and RFS>5 yields significantly higher PPV than RSI alone. Conclusion:Patients with clinical signs and symptoms of LPR based on RSI alone do not demonstrate significant positive predictive value when confirmed with oropharyngeal pH testing, but predictive value is increased greatly when RSI and RSF are combined. Laryngology/Broncho-EsophagologyThe Effect of Nebulized Normal Saline for Postoperative Pain following Therapeutic Microlaryngoscopy Prodip K. Das-Purkayastha (presenter); Maskell Scott; Mereddyd Harries, FRCS Objective: Compare the effectiveness of immediate postoperative nebulized saline, following a therapeutic microlaryngoscopy, for pain relief.Method: Forty patients undergoing microlaryngoscopy were blindly randomized into 2 groups. Twenty-one patients received no immediate postoperative nebulizers, and 19 patients received nebulized saline. Following surgery a blinded observer assessed pain related to the procedure using a visual analogue scale at 1, 2, and 4 hours.Results: Age of patients, size of lesions, and postoperative pain were recorded and statistically analyzed. The age of the patients in either group was not statistically significant. The size of lesions operated on in each group was not statistically significant. The pain at 1 hour and 2 hours postoperation were both statistically highly significant. Conclusion:The results of our randomized controlled trial have shown that following a therapeutic microlaryngoscopy, by immediately administering nebulized normal saline, pain can be easily and safely reduced. Laryngology/Broncho-EsophagologyThe Effect of Singing on laryngopharyngeal Reflux Daniel Steven Fink, MD...